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General NPI Number Information
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NPI Number | 1518658475
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Entity Type | Individual
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Provider Name | KAILA REA EAST PTA
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Gender | Female
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Dates
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Enumeration Date | 05/19/2023
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Last Update Date | 05/19/2023
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Provider Practice Location Address
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Address Line | 234 FOURTH AVE STE 100
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City | SEWARD
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State | AK
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Zip | 99664-4210
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Country | US
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Telephone | 866-238-1168
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Fax |
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Provider Business Mailing Address
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Address Line | 5400 E REVOLUTIONARY WAY
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City | WASILLA
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State | AK
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Zip | 99654-6716
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Country | US
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Telephone | 907-414-0188
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 142490
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License Number State | AK
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